2019 OPEN ENROLLMENT ENDS (most states)

Yeesh! Another crazy day...a third update today, this time for Maryland. The numbers aren't anything exciting (QHPs up about 2,400, Medicaid up a more impressive 10.7K), but every bit helps. The more noteworthy bit of news, however, is shown below--Maryland is finally jumping on the "How many are PAID???" bandwagon and joining 6 other states in breaking out their payment numbers.

While the percentage doesn't look good on the surface (only 54% of the total), the press release is careful to make the same point that I've been making for weeks now: If a big chunk of the unpaid enrollments aren't even due yet, it's rather silly to wring your hands about people not having paid their premiums yet.

No sooner had the January CMS report come out then wham, a new update from Kentucky...unfortunately it's actually a drop in QHP enrollments, since the prior 59K estimate was based on a very general statement by KY Gov. Beshear. As a result, QHPs drop about 5K (from 59K to 54,369) while Medicaid/CHIP enrollments go way up (from 185K to 210,545).

Under @kynectky so far, 210,545 have qualified for Medicaid coverage and 54,369 have purchased private insurance. #ACA

According to a new CMS report released today, between October and January, more than 8.9 million individuals were determined eligible for Medicaid or CHIP through state agencies and through state-based Marketplaces. More than 2 million people were informed in January that they are eligible for Medicaid and the Children’s Health Insurance Program (CHIP); more of those individuals are in states that have chosen to expand Medicaid coverage to more of their residents.

Details to follow, keep watching this space... (or "developing" as some would put it...)

According to a new CMS report released today, between October and January, more than 8.9 million individuals were determined eligible for Medicaid or CHIP through state agencies and through state-based Marketplaces. More than 2 million people were informed in January that they are eligible for Medicaid and the Children’s Health Insurance Program (CHIP); more of those individuals are in states that have chosen to expand Medicaid coverage to more of their residents.

Vermont continues to have impressive enrollment numbers (relative to their population size) despite their ongoing technical problems, partly due to an aggressive SHOP/Small Business enrollment program. Private QHPs have somehow more than doubled from 13,514 paid / 3,392 unpaid as of 2/10 up to 28,486 paid / 4,805 unpaid as of February 25th.

Meanwhile, the SHOP enrollment numbers are also impressive, jumping from 29,200 at the beginning of the year up to 40,000 as of 2/25.

In addition, the article claims that the 28.4K figure only represents policies, not people, which suggests that the actual number of individuals could be as many as 51,200, but I'm already finding it difficult to believe that they've managed to go from 13.5K to 28.4K in just 2 weeks in the first place, so I'm holding off on that factor for now.

The latest figures from the Department of Vermont Health Access, presented to lawmakers Wednesday, show 33,291 individuals have selected a plan and 28,486 are fully enrolled...

After being cited by both the Washington Post as well as PolitiFact as one of only two sources for a reasonably accurate tally of ACA-enabled Medicaid/CHIP expansion (Avalere Health is the other one, although their analysis only included data through the end of December), I decided to go back and review my methodology. I've pored over both the HHS and CMS reports again, as well as reviewing the "Targeted Enrollment Strategy" and other special "bulk transfer" cases.

Nevada's latest update as of 2/22: Paid QHPs have shot up 2,095 from 17,047 to 19,142; unpaid QHPs are down 702 to 7,893 from 8,595, which means that Nevada, like Washington yesterday, is starting to convert unpaid enrollments to paid more quickly. Total enrollments are therefore up just 1,393.

These new enrollees are not all from February; they actually have been scattered throughout the entire enrollment period to date, some going as far back as October or November...but they're not actually being added until this week. This brings the total number of new Medicaid enrollments for Ohio to 129,000:

COLUMBUS, Ohio (AP) -- Ohio officials are preparing to receive more than 106,000 applications for Medicaid-eligible residents who sought health coverage through the federal insurance marketplace.

The first batch of cases, which had been in limbo for months, could be transferred as soon as Wednesday, said Greg Moody, director of the Governor's Office of Health Transformation.

After having my enrollment projection model confirmed by the administration twice in the past week, I thought this would be a good point to see how close I've gotten various milestones since I started this thing:

On a completely separate note, I should also point out that while the actual enrollment period for Private QHPs ends on 3/31/14, we won't know how many actual enrollments there are until mid-April, and we won't know how many paid enrollments there are until sometime in early to mid-May.

WASHINGTON -- Approximately 4 million individuals how now signed up for health care plans under the newly created Obamacare insurance exchanges, a senior administration official told The Huffington Post on Tuesday.

The official press release hasn't been posted to the state exchange website yet, but here's the latest out of the Evergreen State:

Feb 25, 2014 - More than 100,000 Washingtonians have now enrolled in private health plans offered on the Washington state health insurance exchange www.wahealthplanfinder.org, exchange officials said Tuesday.

Overall, a total of 717,933 have enrolled in health insurance on the website.

Here’s the breakdown:

101,857 have enrolled in private plans
202,168 newly eligible residents have enrolled in Medicaid.102,238 who had previously been eligible fro Medicaid but had not enrolled.
311,670 who had been previously eligible for Medicaid who have reenrolled.

And additional 82,249 have enrolled in private plans but have not yet paid their premiums.

These numbers bring WA's Private QHPs up from 90,723 Paid / 85,372 Unpaid as of 2/06 for a total increase of 8,011. More notable is that the state's Paid percentage is slowly increasing, from about 50% a month or so ago up to 55% this week.

OK, I'll have to pull the numbers apart a bit because this story with New York's latest enrollment tally has some overlapping dates and numbers:

More than 800,000 New Yorkers have completed applications to enroll in New York's health-care exchange since Oct. 31, and 501,205 have officially enrolled, a 22 percent increase since Feb. 10, the state Health Department said today....

The state said that 70 percent of those who have enrolled were uninsured at the time of application. But the state didn't immediately say how many of those lost insurance because of the federal Affordable Care Act.

Of the total 501,205 people enrolled, the state said 276,681 chose private insurance plans, while 224,524 qualified for coverage under Medicaid, the government-sponsored health insurance program for low-income Americans.

"Woodworkers", in ACA Medicaid parlance, refers to people who were already eligible for Medicaid coverage prior to the ACA expansion (in states which have done so), but who didn't actually enroll in Medicaid until after October 1st for a variety of reasons, ranging from not being aware that they qualified, to finding the enrollment process too difficult, to not even knowing what Medicaid was before the ACA exchanges launched.

In other words, these are people who already qualified, but were "brought out of the woodwork" to sign up since the exchanges launched in October.

I've been struggling with the question of whether to include "woodworkers" in the Medicaid/CHIP tally or not since I first learned of the distinction between them and the far stricter definition of who should "count" (ie, limiting it to "people who only legally qualify for Medicaid/CHIP due to expansion provisions within the ACA".

There's really two questions here--a philosophical one (should they be included) and a data-driven one (if you do include them, how many people fall into this category?).

Yesterday I posted an analysis of the current enrollment trends and gave a range of possible final QHP tallies through the end of March, ranging from 5 to 7 million depending on a variety of factors. However, I didn't really go into what those factors actually are, so here's a simple list of the forces supporting and opposing higher or lower enrollment going into the final 6-week stretch:

With the October website disaster at HC.gov and serious problems still plaguing some of the state exchanges, is it still even remotely conceivable that private QHP enrollment could reach the CBO's original 7 Million projection? Well, the CBO doesn't think this is likely; they issued a revised projection last month which dropped that projection down to 6 million.

IMPORTANT: I should stress that this ONLY refers to exchange-based, individual/group policy enrollments. It doesn't include SHOP small business enrollments (about 58,000 to date) or direct/off-exchange enrollments (almost half a million confirmed, likely several million more as well). It also doesn't include Medicaid/CHIP enrollments either, though you probably figured that already.

However, let's look at the possible scenarios, about 6 weeks away from the enrollment deadline.

This is a great article; not only does it update West Virginia's Medicaid Expansion tally (up 16,561 from the current 70,574 number), but it gives other useful info, such as the total number of WV residents eligible for the expansion program (130K). Most importantly, it specifically states that these 87K are in Medicaid due to the ACA expansion provision, an important clarification.

According to West Virginia Department of Health and Human Services, over 87,000 residents have been enrolled for health care coverage through the Medicaid Expansion...

Jeremiah Samples, assistant secretary for the DHHS, said that number is about 70 percent of everyone eligible for the expansion....

The total estimated number of West Virginians eligible for coverage under the expansion is 130,000, according to Samples.

By Feb. 13, a total of 87,135 people have enrolled, which Samples said is about 25,000 more than the projected number for 2014.

Well I'll be damned! Oregon has finally managed to enroll a small number of people through their website! (Until today, all 35,247 private QHP enrollments in OR have been processed manually...literally, paper forms filled out by hand and then manually entered into the system). With only 6 weeks to go, this may seem a bit underwhelming, but it's still something...

A Cover Oregon official says insurance agents and community groups have been able to enroll about 700 people in health coverage entirely online.

Chief Information Officer Aaron Karjala revealed the number to a state legislative committee on Friday.

Cover Oregon launched its website for a limited group of experts earlier this week, more than four months after it was originally scheduled to be operational.

There's still no date for when the system will launch to the general public. Karjala says developers are regularly testing and fixing elements of the system.

Individuals working without an agent or certified expert can continue to apply, but Cover Oregon staff will have to process a portion of their application by hand.

Massachusett's ACA exchange website is still undergoing massive technical problems, but there's been significant progress made in processing a mountain of paper applications. The immediate impact isn't that significant (11,000 total enrollments = only 2,861 more than the Feb. 1st tally), but the article suggests that another 50,000 applications should be getting pushed through the system any day now...

As a result, people were urged to file paper applications instead, both to replace expiring policies and to enroll for the first time. The nearest-term problem has been simply processing 72,000 applications, many of which come from uninsured residents....

Overall, a spokesman for the marketplace said that there have been about 11,000 people who have newly enrolled successfully for coverage since October, almost all in unsubsidized coverage.

Maryland continues to creep along, adding 2,139 to their QHP tally (about 7%) and another 8,581 to their Medicaid enrollments (a bit under 6%).

Through February 15,33,251 Marylanders have chosen to enroll in private health plans through Maryland Health Connection.

95,889 Marylanders signed up through the Primary Adult Care (PAC) program were automatically enrolled in Medicaid coverage on January 1, 2014, and now have full Medicaid coverage. As of February 18, 2014, an additional 60,672 individuals were newly enrolled in Medicaid effective January 1.

Minnesota issued an official update today (as opposed to the estimate that I came up with a few days ago based on a "nearly 95K" line in an unrelated press release); I was only off by 888 people on the private enrollment side, but by more than 5,500 on the Medicaid/CHIP side of the equation:

ST. PAUL, Minn. — Today MNsure announced that more than 100,000 Minnesotans have enrolled in quality, affordable health insurance through the state’s new insurance marketplace. MNsure is working to enroll thousands more Minnesotans in coverage before open enrollment concludes on March 31, 2014. Today’s new milestone highlights the progress MNsure has made to significantly improve its performance, and the services it provides to Minnesota consumers....

Well this was unexpected...apparently at a fundraiser, President Obama gave a very rough update on the current ACA exchange tally:

President Obama said Thursday that "close to 4 million Americans" had signed up for insurance on the ObamaCare exchanges, a hint that enrollments may be accelerating as the deadline to purchase coverage nears....

"Right now, we've already got close to 4 million Americans who signed up for exchanges," Obama told a gathering of Democratic donors and governors at a luxury hotel just blocks from the White House.

Quite a day for Direct/Off-Exchange Enrollment news. First the Washington revelation, now this profile in USA Today of eHealth Insurance, a private web-based health insurance exchange that's seen tremendous success selling ACA-compliant plans to people who don't qualify for tax credits through the government-run exchanges.

Not exact numbers, but these are reasonable given the previous breakdown (49,662 Private / 181,705 Medicaid): KY Governor Steve Beshear announced that the combined total of enrollments in Kentucky has hit 244,000, broken out roughly 25% to 75%, which would be 61K private, 183K Medicaid. However, to be safe I'm erring on the side of caution and making it 59K Private / 185K Medicaid until a formal press release comes out.

[as of Thursday], 244,000 Kentuckians have signed up for coverage through Kentucky's exchange, Beshear said.

About three-fourths of them enrolled in the state's expanded Medicaid program and the rest in private insurance plans. The state's performance has earned praise from PresidentBarack Obama.

No fuzzy terminology here. Unlike some other Medicaid enrollment data which leaves you guessing as to whether it's "expansion", "base churn", "redeterminations" or "woodworkers", this AP article is pretty clear and to the point:

COLUMBUS (AP) — More than 23,000 low-income Ohioans enrolled in Medicaid last month under an expansion of the taxpayer-funded program supported by Republican Gov. John Kasich.

That's about 6 percent of the roughly 366,000 residents who the state projected would be newly eligible for coverage by the end of June 2015.

The state's monthly report on Medicaid caseloads does not include those who have applied to the health program for the poor and disabled. But the numbers released Monday provide the first glimpse as to how many people have successfully enrolled under the expansion. The report shows 23,156 residents have obtained coverage so far.

For months I've been trying to hunt down the ever-mysterious "Off-Exchange" private QHP enrollment data...people who have purchased new, ACA-compliant healthcare policies since October 1st, but have done so directly via the various insurance companies. These are, for the most part (at least in the states which haven't granted a 1-year extension of non-compliant policies) the same (or very similar) policies as those sold via the exchanges; the enrollment process simply bypasses the exchange websites, that's all. There are several reasons why people do this; the most obvious is if their taxable income is too high to qualify for an ACA subsidy. Why go through the hassle (on some exchange sites, not others) of jumping through the extra hoops of the Exchange process if you're certain that you aren't going to qualify for a tax credit anyway? In other cases, the insurance company itself may have made some sort of special offer for enrolling directly (or, in some unfortunate cases, they may have pretended that it was a better deal or not even mentioned the exchange as an option).

In any event, this data is difficult to hunt down because unlike the Exchange enrollments, the insurance companies are under no legal obligation to make it public (at least I don't think they are...possibly in their quarterly SEC filings or something?) Until today, I only had hard numbers from 2 companies: WellPoint, whose CEO revealed last month that about 19% of their enrollees since October 1st have been signed up directly. I don't have a more recent update on this, and he didn't break those numbers out by the half-dozen or so states that WellPoint operates in, but that's still 95,000 people. In addition, one other company, a Co-Op that operates in Iowa and Nebraska, cheerfully provided a full breakdown of their enrollments. Add these together and you have about 124,000 people...until today.

Hot off the presses (well...ok, hot off a CT Mirror reporter's Twitter feed, anyway): Connecticut is reporting an additional 3,000 private QHP enrollees over the past week (up to 53,673 on 2/18 from 50,665 as of 2/10), and an increase in Medicaid enrollment of around 1,600 people. They also apparently have a "paid" rate of at least 91% ("low 90%"):

As of midnight Tuesday, Access Health CT had 126,653 enrollees, including 53,673 signed up for private insurance.

So, how does this impact the "February Drop-off" factor? Well, previously CT's February enrollment was running about 39% below January; this has improved to only 19% lower per day, which has the effect of increasing the overall daily average a bit, even after adjusting to only include the 91% paid enrollments:

Eureka! That rarest of things, a mid-month enrollment update from a federally-run exchange state! Idaho reports hitting 38,000 private enrollments, up from 32,899 as of February 1st (I'm sure this is private enrollments only, because they were already at over 16K Medicaid enrollments as of 2/01. It's a short article and the whole thing is a gem, so here it is verbatim:

Idaho’s state-based health insurance exchange has now enrolled 38,000 people in health insurance, state Department of Health & Welfare Director Dick Armstrong told lawmakers today. And another 56,000 are “in the queue,” in the process of enrolling. “Our original target was 42,000,” he said, for signups by the end of the open enrollment period at the end of March. “Very rapidly, Idaho’s enrollment … has come up.”

When the exchange opened and faced problems due to computer system hang-ups in Washington, D.C., initial enrollment numbers were very low. “Everybody was just wringing their hands,” Armstrong said. “This is a breath of fresh air, to see that the enrollments are picking up this rapidly.”

One more very small update today. This isn't an official data release, but this press release from yesterdaymentions the total enrollment in Minnesota as being "nearly 95,000". This presumably includes enrollments through 2/17.

Assuming the same 32% / 68% ratio between existing private QHPs and Medicaid enrollments in Minnesota, this should break out to roughly 30,200 Private / 64,700 Medicaid, an increase of around 700 and 1,700 respectively.

Today, MNsure announced new TV and radio ads that tell the stories of Minnesotans who have used MNsure to find better, more affordable health care coverage. The ads highlight the affordability of MNsure plans and underscore the fact that MNsure offers the lowest premium rates in the country – with additional financial help available through tax credits. The ads are aimed at encouraging more Minnesotans to enroll in affordable, quality health coverage before the March 31 deadline. Nearly 95,000 Minnesotans have already selected health insurance through MNsure.

Yes, it's true...sort of. With the addition of the latest numbers from Colorado, Hawaii and especially California, if you include all ACA Exchange-based enrollments reported to date--both paid and unpaid--the total currently sits at a tad over 3.56 million people. The original CBO projection for exchange-based private QHP enrollment was 7 million, so we've finally hit the halfway mark. Of course, the enrollment period itself is actually over 77% of the way through, so this is more of a purely symbolic milestone than anything else, but it's still worth noting.

There's a few additional caveats as well, of course; if you remove all enrollments known to be unpaid (about 265K) from the 5 states which have broken that out, and then subtract another 10% from the remaining 46 states, you'll only have about 3.05 million enrollments which are paid (or unpaid due to billing problems on the insurance company's end,which can hardly be blamed on the customer or the exchange system). However, this works out nicely as well, since 3.05 million is still over 50% of the revised CBO projection of 6 million total!

A flood of new enrollment data today! Colorado just posted their latest update, which runs through 2/17. Private QHPs are up from 69,627 as of 1/31 to 79,779 as of 2/17 (an increase of 10,152), while Medicaid enrollments are up to 128,219 from 117,607 as of Jan. 31st (an additional 10,612).

This is also more good news for the "February Drop-off" issue, since this knocks the likely drop-off in average daily enrollment from 11% down to 10% even:

This moves the likely February enrollment up from 820K to 830K, based on 13 states representing 98.7 million people, or 31.4% of the country.

Since the grand total was almost precisely 3.3 million as of 2/01, adding 830K in February would bring the total up to 4.13 million.

There's so much info in today's California press release I've had to move the Medicaid info to a third entry. There's a ton going on in the following passages:

Additionally, 877,000 applicants were determined to be likely eligible for Medi-Cal coverage. DHCS also transitioned 652,000 individuals into the Medi-Cal program from the state’s Low Income Health Program. Automated enrollment allowed county human services agencies to enroll 106,000 individuals into Medi-Cal coverage, and another 65,000 were enrolled through the Express Lane program.

approximately 1.5 million additional Californians have enrolled or been found likely eligible for Medi-Cal since October.

** Does not include applicants for current Medi-Cal coverage through county human services agencies.

OK, let's break this out: The 877K figure is up fro 850K in the January HHS report, which itself was already up from 584K as of January 15, which means a ton of new people enrolled in the 2nd half of January alone.

OK, so this really does mean all enrollees. Fair enough. The downside is that I have to move 165,272 people over to the "Unpaid" category. The upside is that the "How many have PAID???" question just became about 12% cleaner.

Well THAT just figures! In the words of Emily Litella..."Never mind..."

Hot off the presses: California has released their first-half of February enrollment data: 100,228 people have enrolled in Private QHPs in "the first 2 weeks" of February (actually February 2 - 15, I assume, since the 728K number includes Feb. 1st). This breaks down to 7,159/day:

Nearly half of those covered [through 2/01] — 728,410 Californians — selected a Covered California health insurance plan. This strong enrollment trend is extending into February, where in the first two weeks more than 100,000 individuals enrolled in Covered California, increasing the cumulative total enrollment in Covered California to 828,638.

California's January enrollment rate was (728,410 - 498,794) = 229,616 / 35 days = 6,560/day, which means that their February enrollment rate is actually increased from that of January, by over 9%!

So, how does this impact the "February Drop-Off" factor? MASSIVELY! Take a look:

They also list the number of employers enrolled in their SHOP system, but there's no update on the actual number of people covered by those plans, so it stays at 307. No Medicaid/CHIP update either.

The good news is that Hawaii becomes the first state of the 11 for which I have partial February data to actually increase it's enrollment rate over January. The bad news is, Hawaii's numbers are so tiny that this is a drop in the bucket, only reducing the overall drop percentage by 0.2%.

I know I've become a bit obsessive about this "February Drop-off" thing, but I couldn't help myself. Since the Jan. HHS report was simply wrong on New York's private QHP figure, I found the closest correct figure to Feb. 1st that I could--an official NY State of Health press release from 2 days later, Feb. 3, which gives the correct private QHP enrollment number as 241,242 as of Feb. 3.

Updating the "Feb Drop-off Chart" with this info as well as yesterday's Nevada update, we now have some more solid Feb-vs-Jan data to work with. I've modified the graph to show how many days are being counted for each state, as well as the starting & ending dates for each month:

This morning I noted that New York has seen a dramatic increase in the percent of their ACA enrollees who were previously uninsured, rising from 66% of the total on 1/10 up to 69% as of yesterday. While a 3% increase doesn't sound like much, this is especially notable because, as I demonstrated, it means that between 92 - 100% of the newest enrollees were previously uninsured (probably around 95%), since that's what it would take to raise the overall enrollment up with such a comparatively small number of additional enrollments.

However, I forgot another, earlier NY update which fills in this picture even further. Back on January 13, there was another press release which noted that as of December 24, 2013, about 50% of the 230,624 New York enrollees were previously uninsured:

Ah, just in time to help clear up my confusion about the New York situation from over the weekend: The latest tally has NY with a total of 266,177 private QHP enrollments, up 14,871 from 251,306 a week earlier. Medicaid enrollment via the exchange is up to 189,865 from 160,915, an increase of 28,950.

This is noteworthy for a couple of reasons. First of all, this gives some additional, solid data to plug into my weekend "NY Enrollment Number Mystery Project" that I've written a couple of posts about the past few days. Connected to this, however, is something which may be cause for a bit of concern--up until now, New York has been bucking the tide and averaging around a 60/40 split in favor of private QHP enrollments. Today's additions, however, reverse that with the numbers switching to 34/66 in favor of Medicaid enrollments:

Another 44,000 people enrolled in a health insurance plan through the state's exchange over the past week, pushing the total to 456,042, according to the state Department of Health.

Earlier today, I pointed out some potentially bad news for total ACA enrollment: that February's enrollment tally is likely to be a good 20% lower than January's for the simple reason that the February HHS report is only going to include 4 weeks' worth of data, while January's included 5 weeks. Nothing neferious or evil going on here, just measuring 28 days instead of 35 (for the record, the final report for March will include 30 days' worth of data (March 2nd - 31st)).

While writing up the main part of the entry, however (which addressed a Yahoo Finance article which claims that February enrollments will be way down for a variety of unrelated reasons), I noticed something very curious about New York's enrollment numbers. I went into this in the earlier entry but decided that it's important enough to merit it's own full repost.

Here's the official enrollment numbers from the October, November, December and January HHS Reports...and the most-recent official press release from the NY State of Health Exchange:

Most ACA critics now grudgingly admit that people are getting insured after all, but they say there's a catch. "Where are we going to get all the doctors?" a social worker asked me recently. "We're overwhelmed as it is." A letter in the local paper said, "People aren't really covered unless someone accepts their 'insurance', and if nobody is accepting it, then why should people pay for it?"

I briefly answered the letter writer online, saying that the solution was in the provisions of the Affordable Care Act to increase the primary care workforce, not only with more primary care doctors but also more nurses, nurse-practitioners and physician assistants. I was then curious to find out more about what the ACA has been doing to upgrade primary care in the U.S. and found that it has already made major improvements.

NewA couple of weeks ago I predicted the total January Private QHP enrollment number with accuracy that surprised even myself (I called it at precisely 3.3 million; it came in at 3,299,492).

I also gave airy, back-of-the-napkin predictions for February and March, figuring that February would come in at around 1.14 million in Febuary and between 1.5 - 2.0 million in March, for a final total of roughly 6.0 - 6.5 million enrollments. Note that this does not take into account the "paid vs. unpaid" factor, since some people won't be paid in full until mid- to late-April or beyond.

This just in...Kentucky's latest update has KY Private QHP enrollment up to 49,662 from 48,611 on February 1st (a modest 2% increase) and Medicaid enrollment up to 181,705 from 155,172 (a 17% increase).

231,367 Kentuckians are enrolled in new health coverage through @kynectky. If #ACA is repealed, 231,367 Kentuckians are SOL. #kysen

Maryland's Private QHP enrollment is up to 31,112 (up from 29,059 on 2/01), and their Medicaid/CHIP enrollment has increased to 52,091 people plus another 95,889 transfees from the Primary Adult Care program; this is up from 44,592 Medicaid + 95,824 PAC transfers a week earlier.

Through February 8, 31,112 Marylanders have chosen to enroll in private health plans through Maryland Health Connection.

95,889 Marylanders signed up through the Primary Adult Care (PAC) program were automatically enrolled in Medicaid coverage on January 1, 2014, and now have full Medicaid coverage. As of February 11, 2014, an additional 52,091 individuals were newly enrolled in Medicaid effective January 1.

Now that the dust is settling on the January HHS Report and I've had a chance to fully tackle the "But how many have PAID???" issue, I decided this would be a good point to do some cleaning up of The Graph.

Secondly, now that I've switched both the Medicaid and Private QHP numbers over to a "range" format, I've decided to drop the Grand Total numbers from 2 decimal points to one (that is, the range is now 8.8 - 14.4 million instead of 8.78 - 14.46). All of the numbers involved are large enough now that it doesn't make sense to be so anal about it anymore (don't worry, the actual spreadsheets will remain as precise as I can make them).

Well how do you like that? Here I go and spend all morning crunching numbers, reviewing different state reports and so forth...and a few hours later the New York Times goes and makes my point for me:

WASHINGTON — One in five people who signed up for health insurance under the new health care law failed to pay their premiums on time and therefore did not receive coverage in January, insurance companies and industry experts say.

Paying the first month’s premium is the final step in completing an enrollment. Under federal rules, people must pay the initial premium to have coverage take effect. In view of the chaotic debut of the federal marketplace and many state exchanges, the White House urged insurers to give people more time, and many agreed to do so. But, insurers said, some people missed even the extended deadlines.

OK, now that the January numbers are out, let's take a look and see how the individual states are doing. The wonderful Kaiser Family Foundation has a much more sophisticated version of this, but my spreadsheet has two features theirs doesn't: Ugly color-coded cells...and more recent enrollment data for 13 states.

While including post-February 1st data fro some states but not for others does give a bit of an unfair advantage to those states, it's still worth taking a look at to see how the states are faring.

OK, the anti-ACA talking point of "How many enrollees have actually PAID???" has been one of the most commonly-made attacks on the exchanges since the first decent numbers started rolling in at the end of November. It seemed awfully silly back then, since at the time, the actual coveragestart date was still weeks away. Most people I know don't pay their utility or credit card bills until just before they're due, so it seems disingenuous to assume that a health insurance policy (which could be up to $1,000+ per month for some families) would be any different.

Here's what I said about the issue on January 2nd, right after the first wave of policies kicked into effect:

With all the focus on fixing the problems with the individual/group healthcare exchanges, there's been far less attention paid to the more-troubled SHOP (Small Business) exchanges. The administration had already announced that the HC.gov version (covering 34 states*) wouldn't be launched at all until this fall, and 2 of the state-run exchanges (Oregon and Maryland) recently announced that they'd be offline until well after the end of the March enrollment period as well.

Today, Covered California announced that while their SHOP exchange has been operational (with a small number of enrollments to date), they're shutting it down until this fall as well. This leaves 14.5 state-run SHOP exchanges in operation (and yes, that's 14.5, not 15...Washington State's SHOP is only running in 2 counties at the moment).

Still, the press release does give a slight bump in CA's SHOP enrollment before they stop taking new signups: 4,490 individuals covered, plus another 1,200 being processed, for a total of 5,690. That's where it'll stay through the end of the March enrollment period unless they reverse themselves between now and then.

OK, given how messy and confusing the Medicaid/CHIP situation is, I had to think through the best way to incorporate the January HHS Report into the mix. The problem is that not only are the monthly HHS reports only part of the equation (the January CMS report probably won't be released for another 10 days or so, based on prior months), but it's not a simple "add HHS now, then add CMS later". The two actually intermingle, and some of the caveats and overlapping data changes from month to month, which means that some of the data I include today will have to be modified or removed after the CMS report is released, and some of the data which I've removed will have to be added back in...or part of it will, anyway.

Having said all that, I think I have a pretty good grip on how to do this now:

OK, I've scrambled and have updated the Private QHP spreadsheet with the January HHS Report figures.

While the official number as of 02/01 is just shy of 3.3 million, my spreadsheet includes partial updates since February 1st for several states. As a result, the actual current total is at least 3.43 million in all:

3,149,008 from the 46 states which haven't been separated out between Paid and Unpaid enrollees

169,382 known to be paid enrollments from NV, RI, VT, WA & WI

This adds up to 3,318,390, which is the number that I'm counting towards the "Percent of CBO Projection" total...which I'm now calling 46.9% as of today.

Then, there's another 119,164 known to be unpaid enrollments from NV, RI, VT, WA & WI

Add these all up and you get a total of 3,437,554.

Add in the 124,220 known Off-Exchange Private QHP enrollments and the 54,814 known SHOP enrollments, and you have a grand total of 3,616,588.

Add in the 3,101,000 known "sub-26ers" and this goes up to about 6.71 million people on the Private QHP side.

Until now, aside from the official monthly HHS reports, Vermont's enrollment data has been frustrating--not that it hasn't been available, it's just been released in confusing dollops (Massachusetts falls into the same category). Today, however, the Vermont Health Connect exchange released a detailed PDF that does a great job of answering the key questions--along with one bit of data I haven't seen for any other state so far: The breakdown not only of total Private QHP enrollments, but how many of these started in January, February and (upcoming) March.

Page 6 has the key data: A total of 16,906 QHP enrollees as of 2/10, of whom 13,514 are paid up. Overall, this points to an 80% paid rate, which is very good--but the monthly breakout is even more interesting: January-start enrollees have a 92% paid rate (which you'd certainly hope for by now, considering that we're into mid-February) and February-start enrollees are at 79% paid. The March-start enrollees (14%) are the ones providing the main drag on the total...but this is hardly shocking since the start date for that coverage is still over 2 weeks away.

Minnesota's Private QHP enrollments went up a smidge from 28,611 to 29,493 the first week of February, while Medicaid enrollments increased from 61,784 to 63,005 (Medical Assistance + MinnesotaCare combined). Pretty weak tea, I have to admit.

Just received this bit of negative news out of Wisconsin...apparently half of the WI Private QHP enrollees through the end of December still haven't made their first payments yet:

MADISON (WKOW) -- Wisconsin Deputy Insurance Commissioner Dan Schwartzer says only about half of the 40,752 state residents that signed up for health insurance through the Affordable Care Act have paid their premiums and are currently receiving coverage.

Schwartzer tells 27 News that while some of the state insurance companies participating in the federal marketplace have received premium payments for 65 to 70 percent of those policies, others have seen a payment rate of only about 15 percent.

Between the Avalere reconfiguration, the Washington State double-counting news and this discouraging item out of Wisconsin, this isn't a particularly cheery day for ACASignups.net, I admit.

Since January 9th, Private QHP enrollments in DC are up 40% (from 3,646 to 5,090, Medicaid/CHIP enrollments are up over 80% to 8,451 and SHOP (Small Business) enrollments are up about 5% to 12,639 people.

Since the exchange opened for business on October 1, DC Health Link has enrolled 26,180 people. This includes District residents who enrolled in private health plans and in Medicaid, as well as people with coverage through their employers.

5,090 people enrolled in private health plans through the DC Health Link individual and family marketplace and 965 of those have coverage that will be effective March 1, 2014;

8,451 people gained Medicaid coverage through DC Health Link; and

12,639 people enrolled through the DC Health Link small business marketplace.

Similar to the first three months of open enrollment, the largest enrollment – 37% of enrollees in private coverage (individual not SHOP) through DC Health Link – is 26 to 34 year olds; the second largest is 35 to 44 year olds (21%).

For those who still don't understand why I shifted gears and changed the Medicaid/CHIP enrollment tally from a "solid" 7.6 million to a wishy-washy "range" stretching from as low as 2.4 million to as high as 7.6 million, here's a prime example of the problem:

Everything below except for the "updates since 12/28" and some (not all) of the Special/One-Time Transfers come directly from the official HHS and CMS reports. If their data (and especially their footnotes) are accurate and comprehensive, then everything else should be correct. If any key data from their reports is either missing or incorrect, then obviously the rest of my calculations would be off accordingly.

Washington State just released their weekly update, and as usual it's crisp and clean:

Private QHPs are up to 176,095 (90,723 Paid / 85,372 Unpaid) from 175,595 (88,071 Paid / 87,524 Unpaid); the total only went up a few hundred, but the number of paid enrollments went up about 2,700 people.

Medicaid enrollments are up to 276,263 (184,783 Expansion / 91,480 Woodwork) from 258,087 (172,715 Expansion / 85,372 Woodwork), an increase of about 7% from last week.

The Paid QHP number is up from 9,902 to 14,086 (a 42% jump in the past month) and the Medicaid number is up from 19,941 to 35,821, a whopping 80% jump...but as the submitter noted, the 4,311 people who were previously listed as being moved into RIte Care are no longer listed, so I think it's safe to assume that they're now included in one of the above increases.

Wow, talk about a last-minute update: Just received a tip about Connecticut announcing that they've broken through 120K in either Private QHPs or Medicaid/CHIP today:

(HARTFORD, CT) – Seven weeks ahead of schedule, Access Health CT (AHCT) today announced that it has surpassed its self-imposed goal of enrolling 100,000 Connecticut residents and small businesses in qualify, affordable health care coverage. The total number of enrollees stood at 121,983 as of close of business yesterday. The total number of enrollees in private insurance plans is 50,665 or 41.5 percent of total enrollees.

The 50,665 figure is a 15.5% increase over their January 15 total of 43,840, and the remaining 71,318 is a whopping 69% increase over their prior 42,161 tally.

OK, after discussing the Medicaid/CHIP situation with Caroline Pearson of Avalere Health some more (see her more detailed response to our discussion below), I've concluded there's just too damned much uncertainty and too many variables on the Medicaid side of things to try and pin it down to a solid number. This is why Avalere's own estimates ranged greatly from 1.1 million to 1.8 million people. In my case, both the low and high ranges are higher because I'm including more types and more recent data than they are.

I was thinking of 4 different types of Medicaid/CHIP enrollments: "ACA Expansion Only", "Out of the Woodwork", "Bulk Transfers" and "Renewals/Redeterminations". I've prided myself on successfully eliminating the fourth category, which has no business being included under any definition.

I contacted Avalere and asked them to take a look at my own analysis. Caroline Pearson from Avalere got back to me today via Twitter with the following responses (so far):

Regarding my "apples-to-oranges" comparison statement (ie, that my 7.5M number includes both "newly eligible due to the ACA" as well as "woodworkers", while their 1.8M high-end only includes "newly eligible due to the ACA"), she states:

Ahead of the full January report expected from the HHS Dept. sometime this week, the NY State of Health (New York's exchange) gave out two key numbers. Total enrollments have gone up by over 8% in the past week (from 380,747 to 412,221), which is a nice bump...but the more significant news (politically speaking) is the announcement that 2/3 of those were not previously insured.

ALBANY (Feb. 10, 2014) – NY State of Health (NYSOH), the State’s official health plan marketplace, reported that as of 9 a.m. today, 696,880 New Yorkers have completed their applications and 412,221 have enrolled for coverage since the launch of the Marketplace on October 1, 2013. Sixty-six percent of New Yorkers who have enrolled to date were uninsured at the time of application....

"We are thrilled to see that more than 412,000 people have enrolled for quality, low-cost health insurance and nearly 697,000 have completed applications since the Oct. 1 launch of the marketplace. Also, 66 percent of enrolled New Yorkers were uninsured when they applied,” Donna Frescatore, executive director of NY State of Health, said.

OK, I don't know for sure that they'll release the January HHS ACA Report tomorrow, but the odds are very high that they will--the October report was released on November 13th; the November report was released on December 10th, and the December report was released on January 13th, so it should come out either tomorrow, Tuesday or Wednesday at the latest.

I've already given my prediction for the total Private Exchange-based QHP total, which I figure should come in at around 3.3 million. Some other key things to bear in mind, however:

I'm about 95% sure that the HHS Dept. is going to release their official January ACA exchange enrollment report on Monday. The prior monthly reports have all come out on or around the 10th of each subsequent month, so Monday is the most logical time.

With that in mind, here's my own January prediction (and for the hell of it, February and March as well). Bear in mind that while I'm fairly confident about January, the February and March predictions are sloppy "back of a napkin" calculations:

OK, looks like I misunderstood the wording of the prior update; while 422 is actually a slight increase, I thought that the prior 395 didn't include dependents; apparently it did. Therefore, the tally actually drops from 711 down to 422. Sorry about the error.

As of Feb. 2, 4,319 employees are in the system, but only 273 have enrolled in health plans. Combined with their dependents, a total of 422 people have selected health plans on the SHOP exchange.

Nothing to get excited about here, folks: Hawaii, with one of the most screwed-up exchanges (although also, in their defense, one of the lowest uninsured rates on the country to begin with) has added a whopping...488 people to their Private QHP roles since January 18. Still, a person covered is a person covered...no Medicaid update, however.

Maryland had another few thousand people enroll in the in both Private QHPs and Medicaid over the past week: Private enrollments are up over 8% to 29,059, while Medicaid/CHIP enrollments have increased by 5%, to 44,592. The number of automatic transfers from the Primary Adult Care program also went up a few hundred to 95,824.

Through February 1, 29,059 Marylanders have chosen to enroll in private health plans through Maryland Health Connection.

95,824 Marylanders signed up through the Primary Adult Care (PAC) program were automatically converted to Medicaid coverage effective on January 1, 2014, and now have full Medicaid coverage. As of February 4, an additional 44,592 individuals were newly enrolled in Medicaid effective January 1.

An article in Bloomberg Businessweek about the sluggish early enrollment in SHOP (Small Business) exchanges includes this graphic, which gives updated enrollment data for 5 states. I already have the 2,155 California and 5,000 New York numbers, but didn't have any data for Connecticut or Kentucky until now. Colorado was up to 1,055 previously, so this update bumps it up by 241. Add that to the 500 in Connecticut and 200 in Kentucky, and it's 941 more people with health insurance who didn't have it before. Not much, but every addition counts...

Whew! Lots of updates today, although most of them have been fairly small. Today we see that Oregon continues to make steady progress in spite of their exchange website still being a mess. They've increased their Private QHP tally by another 11% (from 31,664 to 35,247) and their Medicaid/CHIP tally by 16.7% (from 57,858 to 67,517) via the exchange, plus another 475 added via their "fast track" program.

As noted in the previous Oregon update, there's already 120,155 "fast track" enrollees included in the December CMS report, so I'm only adding the difference since then (3,189) to the actual spreadsheet.

OK, don't let the huge percentages fool you...the actual number of Private QHPs only went up from 3,273 to 5,062, and exchange-based Medicaid enrollments increased from 1,058 to 1,396.

Not sure where the article is getting it's "24%" and "34%" numbers, however. 5,062 is 54.6% higher than 3,273, and the combined total of 6,458 is 49.1% higher than 4,331.

Enrollment in new Obamacare insurance plans increased by about 24 percent in the last month, Delaware Secretary of Health and Social Services Rita Landgraf told the Delaware Health Care Commission this morning....

Since enrollment started Oct. 1, 5,062 people enrolled in plans through the insurance marketplace, Landgraf said. Another 1,396 gained coverage in Medicaid, for those whose income is up to 138 percent of the federal poverty level....In all, 6,458 people have new coverage, up 34 percent from the January report.

As contributor deaconblues put it, "First mention I've heard of 30K new people being enrolled into Medicaid (in addition to the 130K transitioned from the CommonwealthCare plans)."

Before delving into the website issues, Patrick said Massachusetts still has the highest coverage rate in the nation at 97 percent and faced unique challenges to implementing the ACA because of past health reform efforts. He noted that on Jan. 1 130,000 subscribers to coverage through the Connector were successfully transitioned to new plans under the expansion of MassHealth and 30,000 new adults and children were enrolled in the Medicaid program.

So, after yesterday's big CBO report which had some interesting (and, in some cases, extremely misinterpreted) points to make about the impact of the Affordable Care Act, today there was another report released today from Avalere Health which has gotten a lot of attention, regarding the number of new Medicaid/CHIP enrollees which have been added specifically due to the ACA. I don't know much about Avalere Health, but they tout themselves as a healthcare think tank/analysis firm. From their "About Us" page:

"Avalere is a vibrant community of innovative thinkers dedicated to solving the challenges of the healthcare system. We deliver a comprehensive perspective, compelling substance, and creative solutions to help you make better business decisions. We partner with stakeholders from across healthcare to help improve care delivery through better data, insights, and strategies."

OK, fair enough. According to Avalere:

Avalere estimates that from October through December 2013, between 1.1M and 1.8M people have newly enrolled in Medicaid as a result of the Affordable Care Act (ACA).

These estimates are concentrated in states expanding Medicaid—with expansion states representing roughly three-fourths of total estimated new Medicaid sign ups.

Now, on the surface, even the high end of this range (1.8 million people) would appear to be wildly divergent from my own recent analysis, which currently has "new Medicaid/CHIP enrollments" at around 7.5 million. However...

Minnesota's Private QHP enrollments went up about 3% between January 18 and February 1st, from 27,775 to 28,611, while Medicaid/CHIP enrollments went up a more dramatic 18%, from 52,225 to 61,784 (when combining Medicaid & CHIP along with MinnesotaCare, which still counts).

Insurance sign-ups through Minnesota's health care marketplace continued to grow into February to more than 90,000 people, but enrollment continues to be weighted more toward public plans over private insurance.

MNsure released its latest enrollment measures on Wednesday, which covered mid-January through Feb. 1. By that date, more than 28,000 people had enrolled in commercial plans — an increase of about 3 percent from two weeks earlier.

In addition, Minnesota's SHOP (Small Business) exchange tally has gone up a bit as well, to 541 employees covered; multiplying this by a conservative average of 1.8 per employee household brings it up to around 974 people covered by MN SHOP plans.

As always, Washington State is the Gold Standard in breaking down their enrollments; Private QHPs are up to over 175,000 (88,071 paid, 87,524 unpaid as of January 30), up from about 168,000 a week earlier. Medicaid enrollments are up to over 257,000 (172,715 newly eligible and 85,372 "woodworkers"), up from about 238,000 the prior week.

Colorado does this odd thing where they simply upload an image file with the latest metrics, which can be irritating but also handy. To that end, here's their latest tally which runs through January 31st:

From this we have the latest Private QHP enrollments up slightly to 69,627 (from a prior estimate of 68,999 a few days ago) and Medicaid enrollments up to 117,607 from 101,730 two weeks earlier. It's important to note that Colorado's Medicaid tally supposedly includes only brand-new enrollees, not renewals. This represents a 15.6% increase from 1/15.

An interesting, but hardly surprising development today: The CBO, which had previously projected that appx. 7 million people would enroll in Private QHPs via the Health Exchanges created by the Affordable Care Act (as well as 9 million additional people enrolling in Medicaid or CHIP thanks to the expansion provisions within the ACA) by the end of 2014 have now reduced both of these projections by 1 million apiece, to 6 million and 8 million in the first year. Thanks to Dan Diamond for bringing this report to my attention.

You have to scroll all the way down to page 108 of the report to find it, but here's the relevant screen shot, and the relevant paragraph from pages 112 - 114 of the report:

4,975 more people enrolled since January 30. No Private/Public breakdown, but based on the existing ratio, I'm guessing around 23% Private QHP / 77% Medicaid/CHIP, or 1,145 / 3,830. This brings KY up to 45,305 and 155,172 respectively.

Add another 55K direct new Medicaid enrollments and you're at 210K on the Public side.

In my prior estimated breakdown, I had NY private QHP's as 237, 411 and Medicaid/CHIP at 106,785. Turns out I was only missing 3,800 on the private side, but they've added an additional 30,000+ more on the Medicaid/CHIP side.

Of the 380,747 who have signed up, 241,242 people have enrolled in private health plans and 139,505 have enrolled in Medicaid.

I should note that just as the Private QHP number doesn't include direct off-exchange enrollments, neither does the Medicaid/CHIP tally; when you add those, the new Medicaid enrollment total comes to over 330,000 for New York.